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113 9 Australia, Canada, European Union, Russian Federation, and Turkey Despite their modest populations, Australia (24 million people) and Canada (36 million people) represent two of the world’s wealthiest economies , while the European Union has the single largest economy and a population exceeding 0.5 billion. The Russian Federation is geographically the biggest country, with a population approaching 150 million, and together with Turkey (75 million people) represents major emerging economies and important members of the G20. Many people are surprised to learn that both extreme poverty and NTDs are also found in Australia and Canada, as well as the European countries and their immediate neighbors, Russia and Turkey. Each has pockets of impoverished people with important NTDs. However, for the most part, these diseases have not been systematically analyzed, and we have much more to learn. Aboriginal Populations in Australia and Canada Although both Australia and Canada are highly advanced and wealthy countries overall, each contains significant minorities living in poverty and affected by NTDs. Those populations are predominantly represented by aboriginal or indigenous populations. Globally, aboriginal groups constitute approximately 5% of the population—almost 400 million people. These groups Hotez.indb 113 6/22/16 11:03 AM 114 Blue Marble Health are especially prone to NTDs and poverty, especially rural poverty, and together account for about 15% of the world’s impoverished population. Extreme poverty and the associated factors of inadequate housing and access to health care, living in degraded environments with low levels of sanitation and nutrition, and forced migrations, are among the factors that contribute to the high prevalence of NTDs among aboriginal groups [1]. Such conditions bear some similarities to populations fleeing conflict areas and living in postconflict settings. In addition, aboriginal populations have been shown to often suffer from high rates of NCDs owing to excessive tobacco use and consumption of alcohol or other substances [1]. Australia. The estimated 500,000 Aboriginal Australians are highly vulnerable to some important NTDs [1, 2]. Their diseases include intestinal helminth infections such as hookworm infection and strongyloidiasis, not unlike the occurrence of those same diseases among populations living in northern Argentina. In the case of human Strongyloides infections, there is also a link in Australia to coinfections with a retrovirus known as human T-­ lymphotropic virus 1 (HTLV-­ 1) [1, 2]. Ectoparasitic infestation with the mite Sarcoptes scabei is also an important yet neglected health issue among Aboriginal Australians, with the prevalence exceeding 10% in northern Australia [3, 4]. Scabies is associated with a characteristic rash that can be intensely itchy as a result of mites burrowing into the skin (fig. 9.1). Hyperinfestation with the scabies mite, a condition known as crusted or Norwegian scabies, can occur and result in severe disfigurement and fissuring of the skin [3]. The condition is highly debilitating and, like many NTDs, can also result in social stigma or exclusion. Both scabies and crusted scabies can also lead to secondary Streptococcus and Staphylococcus bacterial infections, with the former causing either rheumatic heart disease or glomerulonephritis, a kidney disease that can lead to renal failure. Figure 9.1. Hand of an adolescent girl exhibiting scabies infestation with typical secondary bacterial infection. From [4]. Hotez.indb 114 6/22/16 11:03 AM Australia, Canada, European Union 115 Finally, blinding trachoma is another important bacterial NTD, as is melioidosis [4, 5]. As regards the former, Australia is currently the world’s only high-­income country with endemic trachoma [6]. It is also the only high-­ income country with endemic Buruli ulcer [7]. In Australia, mass drug administration could have an important role in reducing the burden of NTDs among Aboriginal populations. Three drugs in particular show promise: ivermectin, albendazole, and azithromycin. Potentially , MDA with ivermectin in combination with albendazole could be used for controlling strongyloidiasis and hookworm coinfections. Moreover, ivermectin MDA may have collateral benefits for the control of scabies in Australia [8], and an International Alliance for the Control of Scabies (IACS) has been established for assessing the global impact of both the disease and opportunities for MDA approaches [4]. Similarly, MDA with azithromycin could help to eliminate blinding trachoma from Australia [1, 6]. Canada. It comes as a surprise to many that the frozen regions of Arctic could host NTDs, but indigenous people (such as the estimated 150,000 Inuit) living in this region, including the Canadian Arctic, frequently suffer from these infections [1, 9]. Many of the Arctic NTDs are parasitic zoonoses acquired from inadequately cooked meat [1...


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